Benefit of opioids for chronic back pain unclear

NEW YORK (Reuters Health) - Findings from a systematic review of published research suggest that opioid pain relievers often provide no advantage over non-opioids for relieving chronic back pain, but carry a high risk of addiction.

Back pain is the second most common symptom encountered by doctors in the US. When treatments such as exercise therapy and non-steroidal anti-inflammatory drugs (NSAIDs) fail to control the pain, doctors may turn to prescription opioid painkillers.

Exactly how often these agents are used, how well they work and just how safe they are, however, are unclear.

Dr. David A. Fiellin, from Yale University in New Haven, Connecticut, and colleagues analyzed data from 38 studies that looked at the use of opioids for back pain.

Opioid prescribing rates for back pain varied widely between studies, ranging from 3 percent to 66 percent, according to a report in the Annals of Internal Medicine.

Pooled data from four studies revealed no significant pain-relieving advantage for opioids over either placebo or nonopioid controls. Similarly, an analysis of data from five studies comparing the relative efficacy of different opioids showed only a nonsignificant drop in pain from baseline.

The percentage of subjects with a substance use disorder at some point in their lives ranged from 36 percent to 56 percent. Up to 43 percent of subjects had a current substance use disorder.

Between 5 percent and 24 percent of subjects showed "aberrant medication-taking behaviors," the investigators note.

"The findings in this review suggest that clinicians should reconsider treating chronic back pain with opioid medications, and consider other treatments with similar benefit yet fewer long-term adverse effects," Fiellin's team states.

SOURCE: Annals of Internal Medicine January 16, 2007.